Thoughts on science, history and philosophy of science, atheism, religion, politics, the media, education, learning, books, films, and other fun stuff.

I am a theoretical physicist and currently Director of UCITE (University Center for Innovation in Teaching and Education) at Case Western Reserve University in Cleveland, Ohio. I am the author of three books: God vs. Darwin: The War Between Evolution and Creationism in the Classroom (2009), The Achievement Gap in US education: Canaries in the Mine (2005), and Quest for Truth: Scientific Progress and Religious Beliefs (2000). Disclaimer: The views expressed in this blog are my personal ones and are not those of UCITE or Case Western Reserve University. If you wish, you can send me an email by clicking here.

July 02, 2007

Film review: Sicko

When I was just six years old, I became gravely ill with polio. Although Sri Lanka had first-rate doctors, they felt at that time that they did not have the specialized services to provide the kind of treatment that was best for me and recommended that, if at all possible, my family take me to England. We were not wealthy, just middle class, and did not have the kind of money that would enable my parents to afford this. But by an incredible stroke of luck, my father just happened to work for the Sri Lankan state bank that just happened to have a branch in England. It was the bank's practice to rotate their officers to that branch and my father was due to go in few years but because of the urgency of my illness, his bosses quickly arranged for him to be immediately transferred to the London branch. As a result we arrived in England and simply by virtue of the fact that we now lived there, I was able to get health care through the British National Health Service.

I remember many, many visits to doctors and tests, followed by major surgery that required weeks of recovery in a city hospital followed by months of convalescence and rehabilitation in a country hospital that was more like a country retreat than a hospital. The single-story wards opened out onto rolling fields and woods. The hospital was for people having extended stays and so we had teachers who came every day to help us keep up with our school work and we also had crafts and games and social events.

Six years later the process was repeated when I required a second major operation to consolidate the results of the first.

I remember my hospital experience as a very happy one, with kindly doctors and nurses, and a caring environment. It is because of all this treatment that I have been able to lead a normal and healthy life since then.

And all this treatment was completely free. No paperwork, no deductibles, no applying for reimbursement, none of the headaches and the sheer bureaucratic drudgery that awaits anyone who gets ill in the US. The only thing that my parents had to be concerned about was my health.

All these memories came flooding back to me when I went to see Michael Moore's excellent film Sicko last Saturday. In his bemused everyman persona, Moore visited Canada, Britain, France, and Cuba and talked to doctors and patients and other people about the treatment they receive. Their experience now seemed the same as what I had long ago: When you get sick, you go to the doctor and the hospital and they treat you as best as they can, according to their best medical judgment.

That's it. It is very simple, just as it should be.

Moore compared this with the nightmare that is the health care system in the US, where your ability to pay and the quality of your insurance coverage is the determining factor in your treatment. Anyone who has had even routine treatment knows the rigmarole that one has to go to check whether the doctor is on the plan, whether the visit or treatment or test or facility is covered, what the co-pay and deductibles are, followed by all the stuff that one gets in the mail that are sometimes invoices, sometimes bills, the many phone calls that have to be made to correct errors and find out information, the haggling with insurance companies over complicated details. The list goes on.

Why this difference? Simple. It is in the US that private profit-making agencies have been inserted between the patients and the health care system. In a revealing clip using the famous Nixon tapes, Moore reveals how this came about. In 1971, Edgar Kaiser (founder of Kaiser Permanente), through Nixon's aide John Ehrlichman, presents to President Nixon the idea of having a private profit-making health care industry. Ehrlichman explains the best part of this plan: "Edgar Kaiser is running his Permanente deal for profit. . . .All the incentives are toward less medical care. . . . the less care they give them, the more money they make. . . . the incentives run the right way."

To which Nixon replies, "Not bad."

Once that private profit element is introduced, the rest follows. It now becomes in the interests of the insurance companies to deny or reduce both coverage and treatment because there is a direct trade-off between profit and treatment. The more treatment the patient gets, the less profit the insurance companies make. And the film shows how doctors working for the insurance companies were rewarded by the amount of care they denied, even if patients died as a result. Some of those people who did these things as part of their job were haunted by what they had done to people in order to increase the profits of the insurance companies.

As I watched, it struck me that the two major surgeries that I received for free in England would very likely not have been allowed by the health insurance companies here because at that time they were considered somewhat experimental. As the film shows, the charge of being 'experimental' and 'condition caused by a pre-existing condition' are two of the many, many excuses used by the health insurance companies to deny paying for treatment.

The film also shows how politicians of both parties are bought and sold by the insurance companies, and how their shills in the media fight tooth and nail the idea of universal health care. These shills for the insurance and drug companies also laughably try to make the case that the people in countries like Canada and Britain and France are dissatisfied with their systems, when in actual fact those people think it is bizarre that we have to make our own arrangements to pay for health care, rather than having it taken care of by our taxes.

Of course those systems are not perfect and people do complain about some things. But when the Canadian Broadcasting System held a poll to select the greatest Canadian of all time, the winner was Tommy Douglas, the socialist politician identified as the originator of the state-financed health care system in that country.

Needless to say, this being a Michael Moore film and one that spotlights a huge business-political alliance, there is a vigorous counteroffensive to discredit it. But CNN did a fact check on Moore's assertions and concluded:

Our team investigated some of the claims put forth in his film. We found that his numbers were mostly right, but his arguments could use a little more context. As we dug deep to uncover the numbers, we found surprisingly few inaccuracies in the film.. . .Moore says that the U.S. spends more of its gross domestic product on health care than any other country.

Again, that's true. The United States spends more than 15 percent of its GDP on health care -- no other nation even comes close to that number. France spends about 11 percent, and Canadians spend 10 percent.

Like Moore, we also found that more money does not equal better care. Both the French and Canadian systems rank in the Top 10 of the world's best health-care systems, according to the World Health Organization. The United States comes in at No. 37. The rankings are based on general health of the population, access, patient satisfaction and how the care's paid for.

So, if Americans are paying so much and they're not getting as good or as much care, where is all the money going? "Overhead for most private health insurance plans range between 10 percent to 30 percent," says Deloitte health-care analyst Paul Keckley. Overhead includes profit and administrative costs.

"Compare that to Medicare, which only has an overhead rate of 1 percent. Medicare is an extremely efficient health-care delivery system," says Mark Meaney, a health-care ethicist for the National Institute for Patient Rights.

I was expecting be angry by what I saw in Sicko and that did happen. Since this was a Michael Moore film, I also expected to laugh and that also happened because there are scenes that are vintage Moorisms. What I had not expected was to be so touched and moved by the human stories. At heart, ordinary people tend to care for one another. The film recounts one story after another of people reaching out across politics and nationality and class boundaries, because illness touches everyone's sensibilities. Scenes like the Cuban firefighters who wanted to honor the 9/11 rescue workers.

The difference is that in the US people tend to think in terms of helping informally, those whom they might know personally, or through charities. In countries like Canada, Britain, France, and Cuba, they realize that this does not work for something as basic as health care. The health of the people is too big and too important to be in the hands of private profit-making companies or charities. The government has to do such things, just like it does the fire departments and police, and they support it through their taxes. There is the sense in those countries that there is a shared social obligation to provide health care for everyone.

The only people who benefit from the kind of system the US currently has are the shareholders and top executives of health insurance and drug companies, and those doctors who aspire to great wealth.

What the US needs is a government-run, single payer health care system.

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Comments

I enjoyed "Sicko" as well. It's difficult to describe, but several times in the film I felt like I was looking into a different universe. When Moore was talking with people from countries that have free universal health care I just could not imagine what that must be like. I don't know why, maybe because I pay for all my health insurance myself, but I think about health care a lot. And I am always fearful that even though I think I have adequate coverage when push comes to shove I may find that I don't. So many things in the film really made you think what it must be like to live in that world and have that mindset. The conversations that he had with doctors where they said that under free universal health care they didn't have to worry about money and could concentrate on healing people was one of those cases. I know that "free" really is the wrong word to use since it is paid for by taxes. But the burden and worry that it eliminates at the time the care is given totally changes the entire picture.

In a larger sense, it's about the kind of world that we want to have, what's important to us, treating people with dignity and how we want to be as a society. Regarding the "socialized" part he brings up a number of good points. For example, are the fire department and police department "socialized"? After all the government funds them and the employees work for the government. But we'd never think of calling a "private" police or fireman. And we'd certainly never go through a middleman to determine whether our house fire qualified for a fireman or whether the crime required a policeman. Should something as basic as personal protection be handled by a "for profit" organization? And it's about treating people equally and with dignity. To me it's a whole different way of looking at some things. It was quite a revelation to imagine what a world like that would be like.

One comment: Blue Cross Blue Shield's started as not-for-profit health insurance and worked well for over40 years until the mid to late 70's. Private insurance got involved, lobbied state ligislatures and US congress and made them give up most of what made them the best of both worlds i.e. government and private. I worked at one where the cost of a claim was less than 7 cents per $ premium. In the late 80's and 90's the US government allowed BCBS of Indiana, Kentucky, Gerogia and California to merge into a for profit company - now how's that for rapping the landscape

I think the basic point is correct, but I would caution against romanticising the modern NHS. It suffers from horrendous waiting times, leading to conditions that could have been averted with early care becoming life-threatening, and the ironically-named NICE does routinely deny people treatments that they could get in other countries because they are 'too experimental'.

That said, having moved to the US and learned quite how horrendously and hopelessly screwed an uninsured person is when they become ill has made me very appreciative of the existence of an NHS, however flawed. Brits can still get private health insurance (and I did when I lived there), but at least there's a minimum safety net for those who can't afford it.

I just saw Sicko and agree with the basic premise: Having a system in which insurance companies are responsible for deciding weather it makes sense for them to spend money on someone's health is flawed.

However, I was quite disappointed by Moore's idealization of the Canadian health care system. Having lived in Canada I know that our system has many problems including long long lines for emergency care and sometimes important surgeries. Why doesn't Moore try to present a more unbiased view of other countries health care system? I don't think this would hurt his cause.

The question is not whether one system has wait times and problems and the others none. All systems have problems and some wait times. What you have to do is compare the wait times in different countries for both urgent and non-urgent care.

I will post something on the wait times issue in the POST SCRIPT on Thursday.

I agree that people need to be treated equally and with dignity in any case. Although Mike Moore did abscure some facts in the film Sicko. He didn't point out all the many negatives of socialized health care. Many of the problems within health care itself are with the hospitals. They try to create situations to cause a woman to have a C-section when its not necessary. Yes there are instances when they are, but the vast majority are not. This puts women at a much greater risk of dealth as well as having other future problems. The money and insurance politics is the blame. In the 1970's the C-section rate was 5% and there was less mortality for mothers and babies. Now the rate is up to 40% in some areas and the mortality rates are among the highest.

As someone who has also lived in both Europe and the US, I loved the film. Of course there are issues in countries that have universal health care - let's remember that's all other 'developed' nations except the US! However if the majority of Americans had the opportunity to experience both systems, I have no doubt in my mind which one they would prefer to have and all this nonsense about socialism would be left in the cold war years where it belongs.

I also agree with the comment above that a profit based medical system leads to more unnecessary c-sections. Studies of California hospitals clearly point to a profit motivation for carrying out c-section deliveries and if done a national survey may well show this s universally true in the US, some hospitals have over 50% c-section rates!